Poly-pharmacy Risk Reduction Program

The first phase of a new MO-PCN program targeting the high utilizers of medications in the MO HealthNet program was launched in mid-June 2016. The program is entitled the Poly-pharmacy Risk Reduction (PPRR) program and focuses on the MO HealthNet population that is taking 12 or more medications. Patient cases are distributed to participating pharmacists to review the medications and report participant drug therapy related recommendations to the participant's physician.

A face-to-face encounter with the patient is not required for the program. Instead, an emphasis is placed on building a relationship between the pharmacist and the participant's physician to utilize a team-based approach to patient care that ultimately results in positive health outcomes for the participant and a reduction in healthcare expenditures in MO HealthNet's pharmacy program.

Outcome measures regarding: 1) changes in the number of chronic medications being taken by the participant; 2) changes in medication cost PM/PM and 3) changes in the number of hospitalizations, re-admissions and ER visits are being tracked. Goals of the program are to ensure that an indication for use exists for each medication, improve medication adherence, and design more balanced medication regimens based upon appropriateness, effectiveness and safety. 

The CMS-1500 form is being utilized, initially, for submitting claims to MO-PCN. Special codes and modifiers are being used for the invoice and payment process. Pharmacists are reimbursed for their services based upon increments of time. Payments for submitted and approved claims are made by MO-PCN by the 10th day of each month following claim review and approval for payment.

Funding for the first phase of the PPRR program was appropriated by the Missouri Legislature through June 2016 to launch the program. Additional funding was appropriated for the second phase to continue the program throughout the state of Missouri's 2017 fiscal year. Positive patient and economic outcomes will provide the potential for continuation of the program beyond fiscal year 2017.

Recruitment of pharmacists for the second phase is underway. Requirements for pharmacist participation in the PPRR program include:

1. Being a MO-PCN member either as an individual or through a business entity (no cost).

2. Having the MTS designation on their MO Board of Pharmacy license (or working towards).

3. An individual NPI number.

4. Being a MO HealthNet Provider with an active provider status (or working towards).

5. Completion of the PPRR program orientation webinar.

6. Obtain access to the MO HealthNet CyberAccess E.H.R.

Assistance will be provided to you for these items as you progress through program enrollment. Patient assignments will be delivered to pharmacists via encrypted e-mail. To open the files, pharmacists will need:

1. An e-mail account that is compatible with Sophos encryption software. Most domains are, but if yours is not, you may need to set up another account.

2. Supported PDF readers. Supported PDF readers include Adobe Reader 7.0 and later on Windows.

3. Ability to read Excel 2016 files. Excel 2007 and later is recommended. You can save a file as Excel 97-2003, but some of the formatting could change.  

4. Ability to send PHI securely (i.e. fax or encrypted e-mail).

If you are interested in participating in PPRR, please contact Robyn Silvey at [email protected] or (573) 636-7522.